Virtual Nurses in a Virtual ICU – Will Technology Trump Staffing?

Virtual Reality Headset Prototype (circa 1968). Photo by Pargon, via Flickr.

If you want to know what the ICU of the future will be like, think of an extremely ill patient connected to myriad tubes and monitors; watched by cameras; every sigh, snore, or change in breath sound picked up by an audio feed.

Then remove the patient, leaving just monitors, speakers, and video screens.

The ICU—or virtual ICU (vICU, also sometimes called eICU)—may be hundreds of miles away from the patients, located in an office building like any other, with nurses and physicians seated in front of banks of flat-panel screens, monitoring patients from a number of facilities or across a large hospital system.

In a session presented at the American Association of Critical-Care Nurses National Teaching Institute in New Orleans last week, Margie Fortino, MSN, RN, operations director of the Penn E-lert eICU at the University of Pennsylvania Health System, explained how vICUs (or eICUs) are being used not only to bring the resources and expert care of experienced specialists to rural facilities, but also in large medical centers to increase safe outcomes. The premise is that “an extra pair of eyes”—even though they may be many miles away—can catch patient problems earlier, especially during shifts where staffing may be leaner.

Fortino noted that a vICU nurse may watch 40 screens—more on the night shift—and use live audio and video to “assess” a patient when something triggers an alarm. The nurse can then alert the actual hospital nurse responsible for the patient. Often, a physician will also work the night shift in a vICU, acting as the “on-call” physician available to diagnose and order medical interventions—which are then implemented by the bedside health care providers. Initial data show promising results, with earlier interventions leading to decreased length of stay in ICU and reduced costs. Impressive, to be sure.

This technology may allow nurses who may not be able to physically work at the bedside to continue to use their knowledge and experience. And I’m all for technology that increases safety in health care.

But I can’t help wondering: wouldn’t better nurse-staffing ratios also provide that “extra pair of eyes”? How much money spent on the new technologies hailed in many health care reform plans could be spent providing adequate staffing? We already have plenty of data showing that increasing nurse staffing leads to better patient outcomes. When will people get excited about solving the problems that are right in front of them?

Shawn Kennedy, MA, RN, AJN editorial director